Healthcare Provider Details

I. General information

NPI: 1144733767
Provider Name (Legal Business Name): JILLIAN BRYNN GOLDNEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41810 N VENTURE DR UNIT D136
ANTHEM AZ
85086-3174
US

IV. Provider business mailing address

20401 N 73RD ST STE 230
SCOTTSDALE AZ
85255-4153
US

V. Phone/Fax

Practice location:
  • Phone: 480-556-0446
  • Fax: 480-556-0447
Mailing address:
  • Phone: 805-560-4464
  • Fax: 480-556-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: